New Member Signup

Please complete the WMCW Member Registration Form. Your personal information will not be shared.

Personal Information

First Name

Last Name

Email Address

Primary Phone

Alternate Phone Please only provide if you don&#x27;t have a cell phone.

Address

Address Line 1

Address Line 2

City

State

Zip

Instrument

Primary Instrument

Secondary Instrument If you play another instrument with proficiency, please select that instrument.

Emergency Contact Information

Emergency Contact Name

Emergency Contact Primary Phone

Can we send TEXT Message to Primary Phone? (required) Yes No

Emergency Contact Alternate Phone

Can we send TEXT Messages to Alternate Phone? Yes No